Sunday, 21 October 2007

Fun on Night Shift.

Things I could do without on a Night Shift:

How about taking 20 phone calls from relatives at 0700 in the morning because they want to see what kind of night grandad had.

Do I sound like a total bitch?

This is at a time when there is no unit clerk on duty to answer the phone. The only phone this large ward has is pretty damn far from the bays where the patients are located. Great set- up huh?

It is only 30 minutes before I have to give report to the day staff and I have just had a cardiac arrest leading to a death 10 minutes ago (needed to inform the family and should lay him out, document and pack his belongings and clean the bed before day shift arrives).

Had an acute surgical admission arrive on the ward as the cardiac arrest was happening, a terrified LVF patient who is going bad and couldn't breathe and was in AF and needed multiple interventions and meds administered IV, a catheter for low output and fluid balance, and there is also all of the usual morning stuff do to like meds, multiple IV's due that need to be prepared and given etc etc. As usual this stuff is all happening simultaneously and I have to knock it all out in a ridiculously short amount of time and I am the only nurse. Oh. Shit.

There are 10 patients in wet beds and call bells ringing like mad at this time. Four of them were fall risks with dementia and were trying to climb over the side rails. There was only myself and a health care assistant for 20 patients. Couldn't get near the patients because of the phone calls. Trying to keep the LVF man from dying via lack of nursing intervention kept me at his bedside constantly. The doc can order the meds but if I don't give them at all and correctly and don't continually moniter the guy the shit will hit the fan. Should I leave him to deal with the wet beds and then go back to him? He might be dead by that time. I was worried about him, the acute surgical admit who was bleeding heavily and I can't see her from the LVF man's bed. I am worried about other 18 patients who all needed help, especially the 10 or 12 who are lying in their own filth. Others are ringing for pain meds. Leaving LVF man and bleeding out admission long enough to check out and draw up all those pain meds could be fatal. Shit. Shit. Shit.

So I blew off answering the phone and prioritized sorting the LVF guy, the acute surgical admission,and getting in touch with the dead man's family to tell them he was gone and remember to be gentle, calm, sympathetic and supportive even though I was nearly in tears myself. I hate making these phone calls. I would rather eat shit actually. This was an unexpected crash and death. Not pretty.

My HCA busted his ass trying to get to all the call bells, the wet beds, and finish morning observations on 20 people. He couldn't get around to them all himself. He spent most of his time keeping the fall risk dementia patients from landing on their heads. The patients were pissed off at him and complaining about how they were waiting so long and felt rushed when he finally got there. Then they didn't like the fact that he was a "male" "nurse" etc etc.

The phone was ringing non-stop and we blew it off. Felt bad because if my dad was in hospital I would be on the phone to his ward like a shot.

At 0730 I had to leave the floor to give report....rushed and incomplete. That is dangerous in itself. I ran through it quick as we really needed to get our asses back onto the floor pronto to the LVF man who was deteriorating. A bad report could lead to a chain of events that hurts a patient. None of this is good. The day nurses were sympathetic as we all have nights like this. I took over the night before from a nurse who had the evening shift from hell and many things were left undone. Everyone understands. We are a good team.

Can't wait to watch the complaints flood in from patients' relatives saying "I just rang to see how my loved one was and the evil nurses couldn't be bothered to answer the phone Friday morning....and granddad tells me he waited in a wet bed from 0630 until 0800!! Where is matron to whip these nurses into shape?" Um Er ...how about we ask where are the nurses? Oh that's right...they are looking for non-existent jobs.

What a lovely end to a 12 hour night shift. I was supposed to leave at 0800 and got out about 0930. No I won't get paid overtime. As a matter of fact I was off the clock and not getting paid from 0700 onwards as they deduct an hour for breaks we don't get. Getting out at 0930 was not bad considering. Sometimes night shifts are dead easy and sometimes they are like this. More of the latter I am afraid. 99% of them are more of the latter in this place.

I do love nursing but I could really do without all the simultaneous problems at the end of a long shift. That's just part of the job really but another five sets of hands would be nice.

7 comments:

DBA Dude said...

Why don't you management ante up for the cost of an answerphone for the ward which can be switched on when your are too busy?

Because they are the f**ckwits who think that allocating a ward of 20 people with one nurse and one HCA is "an appropriate level of staffing".

I fear an outbreak of extrreme rage coming ny way - must go and lie down in a darkened room.

Zarathustra said...

Hi There.

We've given your blog a plug over on Mental Nurse: http://www.mentalnurse.org.uk/2007/10/25/nurse-patient-ratios-why-they-matter/

Nursing Student said...

It struck me the other night though why patients wife's or husband's ring the ward wanting to know how they are first thing when really, all we ever say is "They are OK".

If anything was wrong, we would have phoned them up before. Do they honestly expect us to say "Huh? Mr Smith? Oh, he died hours ago, terrible shame for him".

Nurse Anne said...

I had my patient's neighbour from twenty years ago calling every hour because she was so concerned. The patient was having a hernia repair. She wanted to know all kinds of details we aren't allowed to give and then she started ringing all the time and got nasty.

We always try and tell people to get one member of the family (patients NOK) to make the phone calls and distribute info the other family members and friends.

Then we get: Well so and so and so and so hasn't spoken for years and so and so doesn't know this persons phone number. So we can have 5 different people always phoning about the same patient. With no one to answer the phone it becomes a problem.

We aren't allowed to tell them a damn thing anyway.

Nurse Anne said...

Thank you for the plug Zarathusta. People need to know what is happening or else things will never improve.

Anonymous said...

I hate 6am onwards on the night shift, it is hell. I make sure that always the IV's,observations and BM's are done for every patient. The wet bed if we don't get round to them we don't get round to it. The early staff will start with the washes so they can start with the ones who will be wet.

I don't know how you cope with only 1 RN, how you do CD's get your Iv's double checked? Even our stroke ward which has maximum of 18 patients always has 3 staff on nights (even though they are generally not full).

have loved reading your blog, can relate so much, actually your ward sounds even worse than mine.

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